Question 1

The nurse is assessing for inflammation in a dark-skinned person. Which technique is the best?

Accepted Answer

Because inflammation cannot be seen in dark-skinned people, palpating the skin for increased warmth, for taut or tightly pulled surfaces that may be indicative of edema, and for a hardening of deep tissues or blood vessels is often necessary.

Question 2

A father brings in his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says his baby has not been able to keep any formula down and that the diarrhea has been at least every 2 hours. The nurse suspects dehydration. Where should the nurse test for skin mobility and turgor?

Accepted Answer

Mobility and turgor are tested over the abdomen in an infant. Poor turgor, or tenting, indicates dehydration or malnutrition. The other sites are not appropriate for checking skin turgor in an infant.

Question 3

A 52-year-old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she first noticed it several months ago and that it has slowly grown larger. The nurse suspects which condition?

Accepted Answer

Basal cell carcinoma usually starts as a skin-colored papule that develops rounded, pearly borders with a central red ulcer. It is the most common form of skin cancer and grows slowly. Acne presents as pustules (turbid fluid filled cavities) that are circumscribed and elevated. Melanoma usually presents as brown (but can be other colors) lesions with irregular or notched borders and may have a flaking, scaling, or oozing texture. Squamous cell carcinoma present as an erythematous scaly patch with sharp margins, 1 cm or more. This description does not fit acne lesions. (See Table 12-11 for descriptions of melanoma and squamous cell carcinoma.)

Question 4

The nurse is preparing for a certification course on skin care and needs to be familiar with the various lesions that may be identified on assessment of the skin. Which of the following definitions are correct? (Select all that apply.)

Accepted Answer

Vesicles are also known as a friction blister; nodules are solid, elevated, and hard or soft growth that is larger than 1 cm.; and petechiae are tiny punctate hemorrhages, 1 to 3 mm, round and discrete, dark red, purple, or brown in color. A hypertrophic scar is a keloid, not a papule. A papule is solid and elevated but measures less than 1 cm. An elevated, circumscribed lesion filled with turbid fluid (pus) is a pustule, no a bulla. A bulla is larger than 1 cm and contains clear fluid.

Question 5

A few days after a summer hiking trip, a 25-year-old man comes to the clinic with a rash. On examination, the nurse notes that the rash is red, macular, with a bull's eye pattern across his midriff and behind his knees. What does the nurse suspect?

Accepted Answer

Lyme disease occurs in people who spend time outdoors in May through September. The first disease state exhibits the distinctive bull's eye and a red macular or papular rash that radiates from the site of the tick bite with some central clearing. The rash spreads 5 cm or larger, and is usually in the axilla, midriff, inguinal, or behind the knee, with regional lymphadenopathy. Rubeola presents as a red-purple maculopapular blotchy rash that first appears behind the ears and then spreads over the face followed by the neck, trunk, arms and legs. Eczema, or atopic dermatitis, is a chronic inflammatory skin lesion that presents as erythematous papules and vesicles with weeping, oozing, flaking, fissures, crusts, and severe pruritis. An allergic drug allergy often presents with a generalized erythematous and symmetric rash.

Question 6

A semiconscious woman is brought to the emergency department after she was found on the floor in her kitchen. Her face, nail beds, lips, and oral mucosa are a bright cherry-red color. What should the nurse suspect is the likely cause of these findings?

Accepted Answer

A bright cherry-red coloring in the face, upper torso, nail beds, lips, and oral mucosa appears in cases of carbon monoxide poisoning. Uremia presents as an orange-green or gray pallor, not bright red. Carotenemia presents as a yellow-orange color in the forehead, palms and soles, nasolabial folds but no yellowing in the sclera or mucous membranes. Polycythemia presents as ruddy blue in the face, oral mucosa, conjunctiva, hands, and feet.

Question 7

A patient has been admitted for severe psoriasis. The nurse expects to see what finding in the patient's fingernails?

Accepted Answer

Sharply defined pitting and crumbling of the nails, each with distal detachment, characterize pitting nails and are associated with psoriasis. Paronychia is red, swollen, and tender inflammation of the nail folds. Beau lines are depressions across the nail that extends to the nail bed. Splinter hemorrhages are red-brown linear streaks from damage to nail bed capillaries.

Question 8

A patient has been admitted to a hospital after the staff in the nursing home noticed a pressure ulcer in his sacral area. The nurse examines the pressure ulcer and determines that it is a stage II ulcer. Which of these findings are characteristic of a stage II pressure ulcer? (Select all that apply.)

Accepted Answer

Stage II pressure ulcers have partial thickness skin erosion with a loss of epidermis or also the dermis; open blisters have a red-pink wound bed. Stage I pressure ulcers have intact skin that appears red but is not broken, and localized redness in intact skin will blanche with fingertip pressure. Stage III pressure ulcers are full thickness, extending into the subcutaneous tissue; subcutaneous fat may be seen but not muscle, bone, or tendon. Stage IV pressure ulcers involve all skin layers and extend into supporting tissue, exposing muscle, bone, and tendon. Slough (stringy matter attached to the wound bed) or eschar (black or brown necrotic tissue) may be present. Intact skin that appears red but is not broken and localized redness that blanches with fingertip pressure in light skinned people both describe a Stage I pressure ulcer. Patches of eschar covering parts of the wound describe a Stage IV wound. An ulcer that extends into the subcutaneous tissue is a Stage III pressure ulcer.

Quiz 13: Skin, Hair, and Nails